What are Kidney Stones?

Kidney stones (calculi) are a common and painful medical problem. Kidney stones build up from a chemical imbalance in the urine. They may be smooth and rounded or make an uneven of the inside of the kidney, completely filling up the small ducts. The irregular stones are sometimes called staghorn because of their shape, or infection stones because they happen during urinary tract infections. Stones become a problem when they leave the kidney and pass through the ureter, causing cramps, pain, nausea, vomiting, and sometimes, blood in the urine. Stones may become stuck in the ureter, causing severe pain or infection.

Kidney stones are most often seen in middle age adults. They are more common in men than in women. They tend to come back repeatedly.

Many factors contribute to the development of kidney stones; heredity, dietary factors, and reasons unknown to modern medicines.

The renal calculi can cause severe pain as they pass from the kidney and travel down the ureter towards the bladder and urethra. Often these calculi become lodged within the kidney or ureter causing retention of urine within the kidney, severe pain, and/or infection. A urologist will commonly place a stent (small tubing) up the ureter to allow urine to pass and provide relief for the patient until the stone passes or is removed. If the calculus does not pass by itself, the urologist will use a surgical procedure called cystoureteroscopy to obtain access to the kidney stone. The calculus can then be removed using a variety of methods. These methods may include grasping the calculus with a basket-like device or even crushing the calculus using laser or shock waves. Patients undergoing cystoureteroscopy usually go home within several hours following surgery. Minor discomfort is expected and often the stent will remain to allow fragments to continue to pass. The stent will be removed at a later date.

WHAT DO KIDNEY STONES LOOK LIKE?

Kidney stones may be small or large and either smooth or jagged. They are usually yellow or brown.

WHERE ARE THE STONES PRESENT?

The stones may be present in the kidney, ureter or the urinary bladder.

WHAT ARE THE SYMPTOMS OF KIDNEY STONES?

Pain

Blood in your urine

Fever and chills

Vomiting

Urine that smells bad or looks cloudy

A burning feeling when you urinate

WHAT DAMAGE DO KIDNEY STONES CAUSE?

Small stones can cause pain as they pass from the kidneys down to the bladder while large stones can get stuck in the kidney or in the bladder and cause pain, infection and kidney damage. Obstruction and infection can result in kidney failure.

WHAT ARE THE TREATMENT OPTIONS FOR KIDNEY STONES?

The complete approach to stone disease involves treatment of the existing stone and preventive measures against recurrence. The majority of kidney stones pass by themselves through the urinary tract and out with the flow of urine. However pain can be so severe that hospital admission and pain medicines are required. Sometimes an open operation is needed to remove stones. Many stones can be removed with endoscopic surgery i.e. extraction with the aid of telescope. Lithotripters are available for the effective treatment of kidney stones with little pain or discomfort using an intense shock wave to smash large kidney stones into small fragments

WHAT IS EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (ESWL)?

During ESWL, the stone is localized using x-rays and high frequency shock waves are focused onto the stone which results in its mechanical disintegration into small particles.

The doctor can see on the x-rays that the stone has been crushed by the shock waves. Subsequently the stone fragments pass out in the urine. This process may require to be repeated for large stones. For large stones and patients with ureteric obstruction, a double J Stent (a temporary ureteric tube) may be needed to be placed by a cystoscope through the normal urinary passage. One end of the stent lies in the kidney, while the other in the bladder with nothing visible from outside. This dilates the ureter and prevents obstruction during the passage of stone particles. When the patient is stone free, the stent is removed with the help of cystoscope.

HOW LONG DOES THE TREATMENT TAKE?

Plan on a four to five hour stay from the time you arrive at pre-admission. The actual treatment will take around a hour to an hour and a half. The extra time is for you to be admitted, evaluated by the anesthesiologist and other physicians, and to recover.

Single small stones may take less time to clear and large or multiple stones will take longer and multiple treatment sessions.

IF REQUIRED WHEN WILL THE TUBE BE PLACED INSIDE THE KIDNEY?

For large stones a double J stent is usually placed before ESWL. This is often done under general anesthesia.

WHAT WILL HAPPEN TO THE STENT IN THE KIDNEY?

The stent will be removed when the urologist determines that the stone is cleared.

DO STONES ALWAYS PASS OUT AFTER LITHOTRIPSY TREATMENT?

Sometime, stone clearance is delayed by a fragment, which blocks the ureter. The doctor may advise the patient to have this removed using ureteroscopy.

WHAT IS ENDOSCOPIC LITHOTRIPSY?

Many stones can be removed without conventional surgery by introducing small telescopes into the body either through normal urinary passage or through a pencil size hole in the skin (the percutaneous approach.

HOW ARE STONES IN THE URETER REMOVED?

Suitable stones within the ureter can be crushed with ESWL, be removed, pushed back to the kidney for subsequent ESWL or broken down by small portable lithotripter under direct vision and removed using forceps. This avoids the need for open surgery.